The impact of three educational strategies on poorly controlled diabetes: An intervention trial

The present study compared the effectiveness of 3 educational strategies aimed at helping patients with uncontrolled diabetes (type 1 and type 2) to achieve glycemic control (good control of blood sugar). All 3 strategies had beneficial effects on glycemic control. Most effective was an intervention based on behavioral group therapy.

Self-care behavior and lifestyle changes can greatly contribute to a successful glycemic control in diabetic patients and thereby prevent some serious long-term complications (eye, kidney, nerve and heart problems). However, little is known about education strategies that can successfully support lifestyle changes and self-care behavior.

In this trial, three diabetes education programs were tested in 222 patients (110 with type 1 and 112 with type 2 diabetes) with poorly controlled blood sugar levels (HbA1 > 7.5%). The interventions were aimed at reaching specific goals (primarily blood sugar control) by providing patients with different forms of educational support. The outcomes of these educational interventions were analyzed separately for type 1 and type 2 diabetes.

Baseline values for glycated hemoglobin (HbA1c; a measure of glycemic control in the past three months), the patient’s self-care behavior (i.e. average number of glucose checks), diabetes-related distress symptoms (i.e. depression and anxiety), and physical fitness were recorded prior to the intervention. Changes in all these parameters were followed up for one year in 3 months intervals after completion of the educational intervention.

Following the initial assessment, patients attended either:

• 5 group sessions of behavioral therapy embedded in a diabetes education program and supported by an instruction manual (structured behavioral intervention),
• 5 group sessions of diabetes education, supported by an instruction manual (group attention control)
• or 6 months unlimited access to individual therapy with a diabetes nurse and a dietitian (individual control).

All educational interventions resulted in an improvement in HbA1c. The highest impact on HbA1c was achieved by the structured behavioral program (mean HbA1c reduction of 0.8%) compared to HbA1c reduction of 0.4% for the other two interventions. On average, type 2 patients achieved the greatest improvement through structured behavioral intervention (HbA1 reduction of 0.7%), whereas type 1 patients did equally well in structured behavioral therapy and individual control (HbA1 reduction of 0.3%).

In conclusion, the trial showed that the most effective supportive intervention in patients with poorly controlled blood sugar is a diabetes specific education program with a cognitive behavioral component, which can support the improvement of blood sugar levels in type 1 and type 2 patients for up to one year.